VT Med chief stakes out stand

December 04, 2004

Brendan McKenna, Barre-Montpelier Times Argus (Vermont)

RUTLAND — The walls of Dr. Harvey Reich's office in the intensive care unit of the Rutland Regional Medical Center are covered with certificates, awards and commendations, but he just waves them off.

The new president of the Vermont Medical Society jokes that he just had to find some way to cover up all the holes in the wall. Reich, who was elected president of the society earlier this year, is director of critical care medicine and respiratory care for the Rutland hospital and a clinical associate professor of medicine at the University of Vermont College of Medicine. He moved to Vermont 10 years ago after serving teaching at the University of Pittsburgh.

Reich, 50, of Mendon, says Vermont doctors and patients are facing serious issues in the coming years, such as the medical use of marijuana, physician-assisted suicide and access to health care. And he's willing to talk about his own views.

For example, Reich says he has reservations about Vermont's legalization of the medical use of marijuana.

'Personally, I'm against that,' he says. 'The laws are not geared toward using cannabis and cannabis derivatives. They're geared toward growing plants in your basement.'

Reich, who says cannabis-derived pills were given out in the 1980s, finds laws that permit growing and smoking marijuana rather than using more traditional forms of medication troubling.

'It seems like that's the first step toward decriminalization, allowing people to possess and grow plants rather than what they truly need for medical care,' he says.

State Rep. David Zuckerman, a Progressive from Burlington who was the lead sponsor for Vermont's medical marijuana law, says legalization of marijuana was absolutely not his goal in writing the legislation.

'That was not the law that was passed and that was not the intent on my part as a lawmaker,' Zuckerman says, chiding Reich for bringing up what he called a red herring designed to play on people's emotions.

Zuckerman says there were good reasons to allow severely ill patients to choose how to take the drug.

'A big issue with people who have HIV is the nausea brought on by taking multiple oral medications to suppress the virus,' Zuckerman says, citing one example. 'So to ask them to take another oral medication to relieve nausea is counterintuitive.'

Zuckerman says most prescription drugs — from oxycontin to morphine — have more serious side effects and are more addictive than marijuana, but Reich says it's hard to say if there are any specific properties of marijuana that can't be replicated by other medications.

Reich says he is also skeptical about proposals involving drugs of a different sort – reimporting prescription drugs from Canada.

He says that that might allow people to purchase prescriptions more cheaply in the short term, but would ultimately just drive up costs in Canada and not really address the rising costs of health care.

A better way to address costs, Reich says, would be to cap the amount of damages for pain and suffering juries may award in medical malpractice cases.

'A lot of medical work done in this country is defensive medicine. … People are scared not to do things because if they don't and something goes wrong somebody will call them on it,' Reich says, adding he doesn't think that awards for actual monetary damages, whether medical bills or lost wages, should be limited.

Reich says that curtailing pain-and-suffering awards and screening out frivolous lawsuits would also help control the rising cost of medical malpractice insurance for doctors.

'We need to make sure only the cases that have some medical merit get there,' Reich says. 'If we get rid of those that shouldn't be there we could get those costs out of the system.'

He notes that Vermont has not yet seen any million-dollar verdicts, but it would only take one to send insurance rates sky high, which could lead to an exodus of doctors from the state.

But Thomas Sherrer, president-elect of the Vermont Trial Lawyers Association, says limiting lawsuits against doctors would do little to address the real problem.

'If you took every medical malpractice premium in the state for every doctor and every hospital, everybody, and also all the money paid for all the jury settlements, verdicts and legal expenses it would total about 1 percent of the total health care dollar in the state,' he says. 'One of the biggest deceptions, there's no other way to describe it, is that medical malpractice suits are driving up health care costs.'

That is especially true in Vermont, he says, where only about 50 of the 6,000 cases filed each year are medical malpractice suits.

'It's not a crisis in Vermont. There are individual doctors and practices here and they're having a tough time and there should be ways to help,' Sherrer says. 'But this should not be a battle between doctors and lawyers. That's what the insurance companies want.'

Reich also speaks cautiously about another issue that divided the medical community a little more than a year ago: physician-assisted suicide.

'I'm not saying it was a bad intention, but it's hard to legislate medicine,' he says. 'All of the cases are very individual and very specialized. If you start getting non-medical people involved who don't understand the idiosyncrasies you may end up with a bad law. People are really wrestling with what the right thing to do is.'

Allen Gilbert, executive director of the Vermont American Civil Liberties Union, argues that the government is already involved.

'The government currently intervenes when they do not allow or discourage through various statutes the freedom of a doctor to participate in end of life decisions for patients,' he says.

Fundamentally, Reich says, Vermonters need to decide whether health care should be viewed as a right and if so, how to pay for it, a proposition he concedes could be expensive if done right.

'In one sense it doesn't make sense to say if you're old we'll provide it for you and if you're really poor we'll provide it for you, but when you're working and struggling, you're on your own,' he says. 'If you give everybody coverage that is so bad that no physician will accept it, you're not solving the problem, but you'll end it politically.'

Reich says any real plan to address the problems of the uninsured will also need to include coverage of eye care and dentistry.

'The economic outlay to do that would be substantial and it's something that tax dollars would have to pay for,' he says. 'But if it's that important, it's worth a couple of tax dollars. You're not going to get the fat out of the system to pay for it. That's just a pipe dream.'

He adds: 'We first need to decide, yes we are going to do it and it's going to be good. Then we'll see what it costs.'

Contact Brendan McKenna at brendan.mckenna@rutlandherald.com.

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